SIPsmartER Southwest Virginia: A systems-based approach to disseminate andimplement an effective sugar-sweetened beverage reduction intervention

 描述（由申请人提供）：与健康有关的研究成果转化为实践的缓慢过程是有据可查的，这延伸到健康素养干预措施。我们的R21应用程序的驱动力是希望通过加快SIPsmartER（一种旨在减少含糖饮料（SSB）消费的健康素养干预措施）的紧急发现的转化，来减少研究管道中的过度滞后时间沿着。SSB消费是一种高度优先的公共健康行为，占美国成年人总能量摄入的7%左右。不幸的是，该应用的目标是弗吉尼亚州西南部的阿巴拉契亚地区，其SSB的全国平均消费量超过三倍。SIPsmartER是一种基于理论的、为期6个月的、多组分健康素养干预措施，旨在减少SSB摄入量，目前正在1型有效性-实施混合随机对照试验中进行测试。这项严格设计的试验的新发现表明，SIPsmartER是减少SSB摄入量的有效干预措施：干预参与者的SSB摄入量显著减少了227千卡/天（95% CI=326，127; p<0.001），而对照组（p<0.001）降低了53 SSB千卡/天（95% CI=326，127; p<0.001）。此外，SSB结果和SIPsmartER完成率不因健康素养状况而异，初步数据表明，SSB减少在干预后一年持续。为了将这些有希望的影响转化为人口层面的SSB减少，需要共同努力，以了解在现有系统内组织层面采用和实施SIPsmartER的可行性，并开发一个实施支持系统，以帮助交付。此外，由于系统提供的SIPsmartER干预将在控制较少的条件下进行，因此有必要确定对SSB的个体水平影响。因此，我们的方法是由RE-AIM（达到，有效性，采用，实施和维护）框架指导，并整合了互动系统框架和先进的战略，以推进组织层面的健康素养。我们的目标是四个医疗服务不足的西南弗吉尼亚州卫生部地区和他们的客户群体，并提出了一个混合的方法设计，包括形成，过程和结果评估。我们的主要目标是开发，建立可行性，并确定SIPsmartER，这将反映系统级的需求和资源特定的SIPsmartER的实施战略的潜在效用，以及建立相关的组织健康素养的一般能力。次要目标是确定组织层面的采用和实施过程，并确定SIPsmartER在现有系统中的个人层面覆盖范围和有效性。目标是建立SIPsmartER实施支持系统，该系统可以在随后的R 01 3型有效性-实施混合随机对照试验中进行测试，长期目标是在公共卫生系统内广泛传播SIPsmartER，以实现人群水平的SSB减少。

 DESCRIPTION (provided by applicant): The slow translation of health-related research findings into practice is well documented and this extends to health literacy interventions. Our R21 application is driven by the desire to reduce the excessive lag time along the research pipeline by speeding the translation of emergent findings from SIPsmartER, a health literacy intervention to reduce sugar-sweetened beverage (SSB) consumption. SSB consumption is a high priority public health behavior and contributes ~7% of total energy intake for US adults. Unfortunately, the targeted Appalachian region of Southwest Virginia for this application exceeds the national average consumption of SSB by more than three times. SIPsmartER is a theory-based, 6-month, multi-component health literacy intervention designed to reduce SSB intake and is currently being tested in a type 1 effectiveness- implementation hybrid randomized-controlled trial. Emerging findings from this rigorously designed trial illustrate that SIPsmartER is an efficacious intervention to decrease SSB intake: intervention participants have significantly decreased SSB intake by 227 SSB kcals/day (95% CI=326, 127; p<0.001) from 0 to 6 months compared to a decrease of 53 SSB kcals/day (95% CI=326, 127; p<0.001) in the control group (p<0.001). Furthermore, SSB outcomes and SIPsmartER completion rates do not vary by health literacy status and preliminary data indicate that SSB reductions are being sustained one year post intervention. To translate these promising effects into population-level SSB reductions, a concerted effort is needed to understand the feasibility of organizational-level adoption and implementation of SIPsmartER within existing systems and to develop an implementation support system to aid in delivery. Additionally, since a system-delivered SIPsmartER intervention would be conducted under less-controlled conditions, ascertaining individual-level effects on SSB is necessary. Thus, our approach is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework and integrates the Interactive Systems Framework and cutting- edge strategies for advancing organizational-level health literacy. We target four medically-underserved Southwest Virginia Department of Health districts and their client population, and propose a mixed-methods design that includes formative, process, and outcome evaluations. Our primary aim is to develop, establish feasibility, and determine the potential utility of an implementation strategy for SIPsmartER, which will reflect system-level needs and resources specific to SIPsmartER, as well as build general capacity related to organizational health literacy. Secondary aims are to determine the adoption and implementation process at the organization-level and determine individual-level reach and effectiveness of SIPsmartER within an existing system. The goal is to have a SIPsmartER implementation support system that can be tested in a subsequent R01 type 3 effectiveness-implementation hybrid randomized-controlled trial, with a long-term goal of broad scale SIPsmartER dissemination within public health systems to achieve population-level SSB reductions.